HomeMy WebLinkAboutMiscellaneous - 570 BOSTON STREET 4/30/2018 570 BOSTON STREET 1
fr 2101109.0-0047-0000.0 \\
J /
I
i
i
I
1
I
1
I
Date
t
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that . . . . . . . . . . . . . . . . . . . . .J. . . . . . . . . . . . . . . . . . . . .
has permission to perform . . �tl' !` "'. . . . . . . . . . . . . . . . .
AA
wiring in the building of . . . . . . . . . . . . . . . . . . . .
`. . .. . .. . . . .North Andover, Mass.
Fee .�`5.. . . . Lic. No.l .5 7 . ��1. . . . . �j . . . �._
ELECTRICAL INSPECTOR
Check# /
11291
L❑� 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c.143,§3L,the
permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed
on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an
electrical permit shall be issued to the person,firm or corporation stated on the permit application. Such entity shall be responsible for the
notification of completion of thework as required in M.G.L.c.143,§3L. '
Permits shall-be limited as to the time of ongoing construction activity,and may be_deemed-by.the-Inspector_of_Wires abandoned.and_invalid-if he—. ._
or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written
application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written
request of either the owner or the installing entity stated on the permit application.
❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of
the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this
purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With
limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was
"in effector existence"during the qualifying period beginning on August 5,2008 and extending through August 15,2012.
ffRule 8—Permit/Date Closed: G d � ** Note:Reapply for new perm
ermit Extension Act—Permit/Date Closed:
i
C� Official Use Only
� Commonwealth of Massachusetts �
it
Department of Fire Services Permit No.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS
.[Rev.im] (leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00
(PLEASE PRINTWINK OR TYPE ALL INFORMATION) Date: //trcr.
City or Town of. NORTH ANDOVER To theIn pector of Wires: -
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) 7� ®S��/ O be17
Owner or Tenant 671 1Dj Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: (,
Completion of the followin table maybe waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA 4/
No.of Luminaires Swimming Pool Above El 11o.o mergency ig ting
rnd. rnd. Batter Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
p Totals: ""' "' ''"""""""" """"""""""' Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other
Connection
Nei.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or E uivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Tnres.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Z /U z- Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE C GE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
X certify,under the pains and penalties ofp rjury,1the information on this application is true and complete.
FIRM NAME: . L �►� (�Z,5G i LIC.NO.:
Licensee: Signature ----SIC.N d
(If applicable enter "exempt"in the lice se na�tmber 'ne. Bus.Tel.No • �/OZ
Address: � �.F,
e / 3 Alt.Tel.No.. •- � `r
*Per M.G.L c. 147,s.57-61,security wo requir s De'parthieit of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent.
Owner/Agent PERMIT FEE. $
Signature Telephone No.
❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the ,
permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed
on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166,§32,an
electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the
notification of completion of the work as required in M.G.L.c.143,§3L.
Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he
or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written
application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written
request of either the owner or the installing entity stated on the permit application.
❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of
the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this
purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With
limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was
"in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012.
❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑
❑Permit Extension Act—Permit/Date Closed:
Trench Inspection
Pass IN Failed IN Re-Inspection Required($.)❑
Inspectors Comments:
Inspectors Signature: Date:
SERVICE INSPECTION:
Pass IN Failed Re-Inspection Required($.)❑
Inspectors Comments:
Inspectors Signature: Date:
PARTIAL ROUGH INSPECTION:
Pass M Failed Re-Inspection Required($.)❑
r
Inspectors Comments: "
a
Inspectors Signature: Date:
ROUGH INSPECTION:
Pass[N Failed 0 Re-Inspection Required($.) ❑
Inspectors Comments:
I
Inspectors Signature: Date:
FINAL INSPECTION:
Pass 0 Failed Re-Inspection Required($.) ❑
Inspectors Comments:
Inspectors Signature: Date:
p g
DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com
M� The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organizatidn/Individual):
Address:
City/State/Zip: Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.�] I ain a sole proprietor or partner- listed on the attached sheet. $ ? F1 Remodeling
\ship and have no employees These sub-contractors have 8. ❑Demolition
workingfor me in an capacity. workers'comp.insurance. 9
y p ty• E]Building addition
[No workers' comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself.[No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs
insurance required.]t employees.[No workers' 1311 Other
comp.insurance required.]
Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. "
Dontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site
:formation.
lsurance Company Name:
ti
olicy#or S61f--ins.Lie.#: Expiration Date:
:)b Site Address: City/State/Zip:
ttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
ne up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
Pup to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
ivestigations of the DIA for insurance coverage verification.
do hereby cer�Vnrre pains altie f perjury that the information provided above is true and correct
i ature: Date: l ZZ
zone#:
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
i
r .
x�.
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written"
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required"
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials V
i
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel. #617-727-4900 ext 406 or 1-877-MASSAFE
evised 5-26-05 Fax#617-727-7749
vjvjw mace anxz/rlia
194 � � 3
-- 26 .
\ \
196QD
I la ?
198 \ 1 Ui
.01
Ile
110,
L O\ ,T 2
AREA — 43,56��5.F. ; \�.
tn;
W RvICE 4
` WATER 5E ,1
\ \
Tb
42' \ \ \ 27'` -
tiY \ P35\ \ \ .
cn
/ 62'
OF - \
P36-2Op
L ILL
//%%.•//r \ ' ILL 202
� SEPTIC
D— OX
/ / TANK 326.00 ILL
'� 200
FND. DRAIN
INV = 196.0 7 DESIGN PARAMETERS
198
NO. OF BEDROOMS 4
DESIGN FLOW 440 GAL/DAY
LIMIT OF TOPSOIL. AND SUBSOIL PERC RATE USED 10 MIN/IN
EXCAVATION: 5' AROUND TRENC ES
SOIL CLASS CLASS li
LOADING RATE 0.60 GPD/SF
NUMBER OF TRENCHES 2
N/F DOROTHY BRAGEN TRENCH WIDTH 4 FT
BOTT
TRENCH SIDEWALL 1 FT
t96 TRENCH LENGTH 62 FT SIDE
BOTTOM AREA 496 SF I FAC
Tr/ :.'North Andover Page 1 of 1
NORTHANDOVER I
[J Base ltap Zoning2012 Aerials Watershed Zone I Utilities (] Size C1E] Selection
Legard Location k
Help Scale 1 58 _.ft _. ...... _._.
._ " .
e
�jSelct..........
._...__ ........ ......
_
(show all).... ----
Owner Prop ID
r 'O'MARA.JAMES) 109.0-0047-0000.0157
�c 'k� 1plllQi3
ins
R2 1bil6i# 0570
f IFB.!l6IS
lO:fl�tl ,
a'
1 selected To Mailing Labels To Spre.flBuilding Permits I�
[] Property --
Ownerl O'MARA.JAMES J
Owner2 HEIDI P O'MARA
�
Address 570 BOSTON STREET_ 1i3J► tl PropertyID 109.0-0047-0000.0
Lot SLe 43560 S
FiscalYear 2013
Fis Lard Use 101
e Code
Amdev
Last Sale 07/31/2000
1G9A4W Dabe
Book/Page 5820
Total$624500
Valuation
Building CL
Type
Year Built 1998
Get Pictometry Imag Ll Go y'�^ - ._.—•--�
_ - _ .az-o nppc o Save Map as Image Lj L•
sl"�a�:MiarEmm .ewsevs+suezQ rear%egraaala++z�i.rcresueQ ash�aa�e4��losceamaacyccasg
a�Qexe. :e iraiv:atoe+5y�epL'6oenvreg aeeessawraernc�e.7nn•CaaG'J SemaAx�neNr�arP *�r+=9zataen
ern.�mma�eeea�e.iamvenarasgaaw txaGrrce rt�mt�4�icrxsc'akyPsseagrsaml�m
tmrr�rumaese�.Yxasmins Crazugaeim er� ea�enae:ew�saeaa'�'t�+rZrarca.lsa:sv�*mrteer�sro.�.a�ena
acanee aaucraroacmt�utmatlsrt,k7+aGa rfsreiacuxr�caa sneaewm�ss
http://mimap.mvpc.org/NorthAndovermimapNiewer.aspx 12/7/2012
Date . 12--
TOWN
OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that . .
has permission for gas installation . . . Q.r?C. t?!l ..
in the buildings of. . .D rl.6...n.�.. . . . . . . . . . . . . . . . . . . . . . . . . . .
at . . . . .:f!�A. . . . . . C? !�. . � orth Andover, Mass.
r
Fee .19�� . . Lic. No.`./-lw.A. . . . . . . . . . . . . . . . . . . . . . .
GASINSPECTOR
Check#
8502
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY u C
MA DATEIy. 1.a PERMIT#
JOBSITE ADDRESS 5 _ OWNER'S NAME r ��C Q
GOWNER ADDRESS TE1 __ -
TYPE OR OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL E] RESIDENTIAL,
PRINT
CLEARLY
NEWN RENOVATION:El REPLACEMENT:0 PLANS SUBMITTED: YESF- NO❑_I
APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER ._ -, I ,{ ,�_-� -! --.A
DRYER I. J - _�_ m,t .. ..J ► 1 _ _I _
FIREPLACE T _
! FRYOLATOR
FURNACE
GENERATOR p - .- _I L� �I I ! _rf _ _-(. 1 I _!�. ! J i - !
GRILLE
INFRARED HEATER C.-� �-. ! � .-�.- _ _ � _ f� �., -----._ .
LABORATORY COCKS I-- I(+_j{- J _r I -J111,
MAKEUP AIR UNIT _.. . . -
OVEN
POOL HEATER
ROOM/SPACE HEATER
ROOF TOP UNIT1,.:-
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATERI-
nTI-I
INSURANCE COVERAGE
have a current liab_ ility insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO [�I
1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY,! OTHER TYPE INDEMNITY EI BOND 01
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER AGENT �!
SIGNATURE OF OWNER OR AGENT
hereby certify that all of the details and information I have submitted or entered regarding this application are true curate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in co is wit ertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME ' " LICENSE#& GNATURE
MP E-J MGF F-] JP ( JGF _ , LPG! I CORPORATION _I# S!
PARTNERSHIP #__�- -._,,�_—�
❑ LLC
COMPANY NAME: � ADDRESS
CITY STATE=ZIP TEL
FAX �J CELL w-- EMAIL[,.,___�_
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
AZO eLZ
FEE: $ PERMIT#
PLAN REVIEW NOTES 124.
Y
S
} 4
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
UT. www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): /~' ;2
Address:
City/State/Zips �,. e ,s g K:� one
Are you an employer?Check the appropriate box:
Type of project(required):
1,4�0 I am a emp er with 4. ❑ I am a general contractor and I
employees 1 and/or part-time).*� have hired the sub-contractors 6 El New construction
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 1 7• ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers' comp.insurance. 9. ❑Building addition
[No workers' comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs
insurance required.]1 employees. [No workers'
comp.insurance required.] 13.2 Other (a_ri? ��}+y
Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attache g
d an additional sheet showing the name of the sub-contractors and thea workers's comp. ole
r icy mfirmation.
t am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
lob Site Address: City/State/Zip:
attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
,ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
ine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
)f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
nvestigations of the DIA for insurance coverage verification.
do hereby c tify de rye pains and penalties erjury that the information provided above is true and correct.
i na e:
Date:
'hone
Official use only. Do not write in this area,to be completed by city or town official.
i
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Insector
6.Other
Contact Person: Phone#:
F
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 5-26-OS Fax# 617-727-7749
www.mass.gov/dia
Commonwealth of Mas usetts JJ�
fDivision of Registrati 1
Board of Plumb"
" r ROBER m TA
il 177 PRI
a >
C
N CHELM
O
Journeyma r
j GF5100-3 05/01/2014 �M SJB
l 004662
License No. Expiration Date. Serial No.
Date ►2.I. . .
. b�4'SLRD3
TOWN OF NORTH ANDOVER
w
PERMIT FOR GAS INSTALLATION
st
This certifies that . . . s�: .G1(Z .a
has permission for gas installation
in the buildings of. r .'"! M. m. . . . . . ,
at . . . . . .6-�O 4.. . . . . . . . . . .North Andover, Mass.
Fee . 4.�. . . Lic. No. �. . . . . . . . . . . . . . . . . . . . . .
GASINSPECTOR
Check #.
8508
60 C "�a�� m c�� 2j
fe� *Lt It J'��- -I l�
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING rORK
CITY I NORTH ANDOVER MA DATEDEC.5 2012 PERMIT#
JOBSITE ADDRESS 570 BOSTON ST. OWNER'S NAME FZAMES OMARA
GOWNER ADDRESS JAMES OMARA TE FAX
TYPE OR
PRINT OCCUPANCY TYPE COMMERCIAL ' EDUCATIONAL ® RESIDENTIAL "
CLEARLY NEW: RENOVATION:E] REPLACEMENT:® PLANS SUBMITTED: YESE] NO®
APPLIANCES'l FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER
CONVERSION BURNER _
COOK STOVE
DIRECT VENT HEATER
DRYER —
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR 1
GRILLE
INFRARED HEATER _J _
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN — __J --_--
POOL HEATER
ROOM/SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER __-
WATER HEATER l _J
OTHER I INSTALL AN UNDERGROUND _ _-
GAS LINE AND CONNECT A GENERAT
.]III- —AII 1117 — —
INSURANCE COVERAGE
have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES [:]NO
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ® BOND
OWNERS INSURANCE WAIVER:I am aware that the licensee does not have the insurance Y coverage required b Chapter 142 of the
q P
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER ® AGENT
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in ante with all Pertinent rov' ' n of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME I JOHN MARSHALL LICENSE# 778 SIGNATU E
MP® MGF[j JP Q JGF® LPGI CORPORATION[D# PARTNERSHIP[D# -_ LLC®#
COMPANY NAME: EASTERN PROPANE GAS ADDRESS 131 WATER ST.
CITY I DANVERS STATE MA -�ZIP 01923 ]TEL 800-322-6628 -�
FAX CELL EMAIL
41/ X 6r>1 �'
., -,.
a
a
,.
��
<�/2/
��
i -Grirrtr..:orrr�
y '=.. Th a Commonwealth of Massuchi sezz:
Deparrmetz, of IndU.Srrial-,4=idenrs
e o;Invesiioaiions
ConSzr�e' Suite 100
Y Boston 1Y19 02% 74-201,.
��_ = x�w>r.mass.bovidia
Zi� .p A^c" ( mm��n�i1.0.Il1�511IdD� =. I1C2� �L: —FIliZtlbe'S -
s,-F}..`�ricla ._
zv-Dlicano-n
P-ST=RN PROPANO1L
N=t BLsintss/On
roa �-aTion/lndividual',-
= E&
4ddrt s: 01 VVk.TER STREET
City/StattiZip: DANVER' MA 01023 Phone r: 578-75C-550D
Are you an employer? Cher-I the appropriate boT: I Type of project (required):
1.T✓I I aj:n a employer with 4 ' aiTi a genera] conn actor and I `
p. � _I��V,' GOnSTrk1GT10n
employees (lull and/o
have hired the sik--contraciors I
r par-rimej.� listed on the attached sheet. 7. J� F erriodeiing
2.7 1 am a sole proprieior or partner-
ship and have no employees These sub-contractor have o- Demolition
employees and have workers' C addition
worl',-ina for=t in any.capaciiy.. 9. Building
�lD worker' Gomp. insu once comp. irsurance.T
10. �lecmcai repa
' irs or adaitions
required-] 5 F7 -Wt ars a corporation and its � T
officers have exercised their 11.❑ Plumbing r_par, or addition.,
3.❑ 1 am a homeowner doing all wort: Q t of e�em tion -1\iGL
myself- [No workers' comp- n� p p' 1%.❑ P oof repairs
irsuran ce required.] t c- 152, s 1(-), and wt have no GAS F1 i I I N G
Pmployees. [No workers, 13.0 Other
comp. issia'ance required.]
Gey aaplicant thz the LS box rl mis a]so nLi out ttie S5 'OL'aelou showing to wormers comnens�on policy;nT�rr�iaa.
Homeowner who saomir this amdavit iudica g they are domg at wo and tam hire ounsid t c0*u - z,mos submti a nw;affiaaviT in6icIt su:a-
=Conna--or tdat check_this bo,_mis au.2 ar additional s—Ii showing the name of ih:sat-conu-z to s aad scat.wnetn.P or no:(nose=uues have
=ploy=s. Z the sat-cona'zctors have emoloyae-the mist provide thf works' comp.poii�uumbP.
T am_ ¢n errrplayer t1zaT is providing workers'�onzpensatior insurance for my employes. below is the po1z�� and jab sZte
'-YLJOT]?2QaOn-
nsurance Company]name: IBcR
—1y MLTUkL INSURANCE CDJAPAWY
olicy t or Sel -ins. Tic.
WC7-641-435806-052 P pi ationDate: 03 / 15 / 2013
D
Job Sim Address:
kttach a copy of the-workers' compensation policy declaration gage (showing the policy number and e<piration cito-
ailure to secure coverage as required under Section 25A of IVIGL c. 152 can lead to the imposition of criminal penalries Of?-'
7ne up to 51,500.00 and/or one-yea imp 1sonment z<weL as civil penalties in the form of a STOP -WOP:Y ORDER and a tine
)f up to 1250-00 a day against the violator. Be advised that a copy of anis statement may be forwarded to the Office of
.nvestigations of the DIA for insurance coverage-verification.
do hereby certij�- under the pains and penalties ofperiun- that size znform¢tior_provided above is true and corrper
i3 /20i3
�i S1 a-g-,,t
'honey 078-750-6500
F07� e only. Dc not Y✓riL it this area; zo oe compLe£Ed dy cin; or iorvrc 0 Ifi¢L
m n: Permi-L/License_ I
1'SS21Ir1a=^1Tth0'I IL� � C1e-.n�� — - D p ZUr
n - �0 plum _as
... -- --'CSL % r=1..?"�_ --fir. 11It.. lca'_ - _
r1 lnc Vr
.
Baard D1�ieai_� F tic- �t p 1
ri111C1 leNa-
.. 1
6. Other
Contac: Person:
Phone
3
COMMONWEALTH OF MASSACHUSETTS
'.i
PLUMBERS AND GASFITTER$
LICENSED AS AN LP GAS INSTALLER
ISSUES THE ABOVE LICENSE TO: j
,JOHN F MARSHALL
l
47 HHBART STREET
DANVERS MA 01923- 19A5
j
778 05/01/14 184150 I ..
I
i
I
i
I
t
r
i
1600 OSGOOD ST SUITE
Eastern Propane Gas,Inc 36-2
N ANDOVER MA 01845 Check No. 1543
To:Town Of N Andover 56594 Check Date- 12/04/2012
Invoice Number Date Voucher# PO# Description Amount Discount Paid Amount
91271228 12/04/2012 13463 570 BOSTON ST. $41.00 $41.00
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Sub Total $41.00 $0.00 $41.00
G.Total $41.00 $41.00
REORDER 909•U.S.PATENT NO.6538290,5575508,5641183,5785353,5964364,6030DOO
7 51 % Date')/.O. . ........
�ORTq /
o? °� TOWN OF NORTH ANDOVER
f 9
. a
PERMIT FOR GAS INSTALLATION
S SSACHUSE
i
This certifies that . . '1/.r 7.1i✓ C. . . . . . . . . . . . . . . . . . . . . . . . .
has permission for gas installation . .1..,. A .14. . . . . . . . . . . . . . . . . . . .
in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . .
at . . . . . . . . . . . . . . . . . North Andover, Mass.
Fee.I.. . . . Lic. No./.,-?a
G $INSPECTOR
Check# Y "O
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
�j L--U-tr ,Mass. Date FC S 20 /t Permit#
Building Location 6)U -57- Owner's Name Ped ." o
�/ Type of Occupancy lLe s
d
New Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No❑
prCEn UVi
w w � 1:4 oUHxv,
6W W)Gc�7mo ¢ Q ¢� � 0¢ wwd w
7 E rn Zcnv
U � HO w 7 . U > A
O1
oa
SUB-BASEMENT
BASEMENT
FIRST(1 ST)FLOOR
t SECOND(2ND)FLOOR
THIRD(3RD)FLOOR
FOURTH(4TH)FLOOR
+ FIFTH(5T FLOOR
SIXTH(6TH)FLOOR
SEVENTH(7TH)FLOOR
EIGHTH(8TH)FLOOR
Installing Company Name
Address 'Z+ P,-, � S 3 Check one: Certificate
nNAA1Z ,,,,- e, 04orporation .2 6
Business Telephone f- "k- 5r3 - !9� 3 ❑ Partnership
Name of Licensed Plumber or Gasfitter AAAA-4p- 6-'rt, a,r-f c-"i ❑ Firm/Co.
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL
Ch. 142 Yes 94' No❑
If you have checked yes,please indicate the type of coverage by checking the appropriate box.
A liability insurance policy C/ Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required
by Chapter 142 of the MGL,and that my signature on this permit application waives this requirement.
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
I hereby certify that all of the details and information I have submitted(or entered)in above application are true
and accurate to the best of my knowledge and that all plumbing work and installations performed under the
permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State
Gas Code and Chapter 142 of the General Laws.
By Type of License:/ _
Title lumber 9-master Signa re of Licensed Plumber/Gasfitter
City/Town ❑ Gasfitter ❑ ]oumeyman License Number
APPROVED(OFFICE USE ONLY)
PLEASE COMPLETE REVERSE SIDE --►
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Ulf www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information �] �^ a' Please Print Legibly
Name(Business/Orgatiintion/Individual):.4Art Lj,�G co 90 �S
Address: 1 �t AA // S
City/State/Zip: 44 cW LAL^= 4A4 - Phone#: l '� " f-4 G ::Of 5 3
Are you an employer?Check the appropriate box: Type of olect(required):
1. employer I am a em to er with 4. El am a general contractor and I
employees(full and/or part-time).` have hired the sub-contractors 6. New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet.+ ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers'comp.insurance. 9. ❑Building addition t
[No workers'comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.E]Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions �
myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs
insurance required.]t employees.[No workers' 13.0 Other
comp.insurance required.]
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. >> �Q
Insurance Company Name: (i v�` ti C ` __ f tnc P �o
Policy#or Self-ins.Lic.#: k 51 . 3 7 U Expiration Dater
Job Site Address: s1 >_w �i City/State/Zip:
Attach a-copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Signattue_<;36 ��`� Date: y /
Phone#• � 36"' 9 3
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
°•q 9 2 7 Date.... .
f HOR7M�
e�o0L TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
7SSACMusEt
This certifies that S
......... .... ................ .`."`�e.
.(Z-...........................
has permission to perform .....W.� d Vti1 4
......................'.}.... ...................................
+�, CC � ' A
� wiring in the building 1of......1?�.e..t.l..�:�...................... ...'.........................
s 7 U . F✓J 5 I v`� S North Andover Mass.
at.................... .... .................. ,
oo��
Fee..A f0... Lic.No. ..1A`(• ..........................................................
i ELECTRICAL INSPECTOR
C 08:42 M.00 Pala
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer
t Office Use Only
Permit No
^ !£ e0'ffl�JLfn21/�i1Cf' 'fJL�4$$fl�r+rll$G`��$ Occupancy&Fee Checked
i
P-&&S44
U9
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00
Date
(Please Print in ink or type all information) To the I p r of Wires:
Town of North And
The undersigned applies for a permit to perform the electrical work described below.
Location(Street&Number ,5- 70
t�nrtl�ceded
Owner or Tenant -F/ ���L�o� e
Owners Address
Is this permit in conjunction with a building it Yes No ❑ (6eck Appropriate Box)
Purpose of Building Utility Authorization No.
Amps Volts Overhead ❑ Undgmd C1 No.of Meters
E�asting Service
,/a
New Service
Z� Amps zrU Volts Overhead fS Undgmd ❑ No.of Meters
Number of Feeders and Ampacity SS 11
Location and Nature of Proposed Electrical Work AJ��
Total
No.of Lignt8na Outlets No.of Hot fuse No.of Transformers KVA
Above ❑ In ❑ KVA
Swimming Pool and ❑ and ❑ Generators
No.of Lighting Fixtures No.of Emergency ugnting
No.of Receptacles Outlets No.of Oil Burners Battery Units
No.of Swtcn Outlets No of Gas Burners FIRE ALARMS No.of Zone
Total No.of Detection and
No of Ranges No of Air Cond Tons Initiating Devices
Heat Total Total
No.of Oi I No. Pum s Tons KW No.of Sounding Devices
No./of Self Contained
No.of Disnwasners S ace/Area Hearin KW Oetecbon/Sounding Devices
❑ Municipal ❑ Other
No.of Dryers Heatin Devices KW Local Connection
No.of No.of Low Voltage
No.of Water Heaters KW Si ns Bailases Wiring
No.Hydro Massa a Tuds No.of Motors Total HP
OTHER.
INSURANCE COVERAGE. Pursuant to the requiremen8ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES J� NO =
have submitted valid proof of same to the Office YES f- NO = If you have checked YES please indicate the type of coverage by checking the appropriate box
INSURANCE I BOND = OTHER = (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work$ Final
Work to Start Inspection Date Resquested Rough
Signed under the Penalties of perjury: LIC.NO.
FIRM NAMES p p 4
Ucensee �'t Kr!/T /O�v�t� SignatureLIC.NO.�1 Z /1�
' us.Tel No.
Address '?-1 !✓/il� �L� �4` / � ysr�// AItTel.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the Insurance coverage or Its substantial equivalent as required by Massachusetts
General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
Telephone No. PERMIT FEE S
I
(Signature of Owner or Agent)
�'�. .
r
_�_...__
��- c �
����
� � �' �,
l
I
t
` I
k�
��.._.
N2 2466 Date........:,�.. .. l
N°RTl+
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
,SSACHU`��
This certifies that ...... l .................................................................
has permission to perform :-.:.:. .<..- `! ............................................
f wiring in the building of... ¢ ............. ..... .....................................
r
at`�. �... ... ..........................%✓-- .................... ,North Andover,Mass.
+ Fee,R �..... Lic.No.1 / � 1 , r..............
ELECTRICAL INSPECTOR
02/23/99 10:56 35.00 PAID
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
r _
\\ Office Use Only
014e C98mmunwealt4 of Massuclllisetts Permit No.
Mepurttnent of Public 3$ufctg Occupancy& Fee Checked ?S
3/90 (leave blank)
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
i
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 2/5/99
City or Town of NORTH ANDOVER To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) 570 Rf19Tf1N STRFFT
Owner or Tenant ROBERT HARKINS
Owner's Address (978) 682-5431
Is this permit in conjunction with a building permit: Yes ❑ No B (Check Appropriate Box)
Purpose of Building Utiffty Authorization No.
Existing Service Amps —J Volts Overhead ❑ Undgrnd ❑ No. of Meters
1 New Service Amps _� Volts Overhead ❑ Undgrnd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total
KVA
No. of Lighting Fixtures Swimming Pool Above In-
grnd. Elgrnd. ❑ Generators KVA
No. of Emergency Lighting
No. of Receptacle Outlets No. of Oil Burners Battery Units
No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones
No. of Ranges No. of Air Cond. Total No. of Detection and
tons Initiating Devices
r Heat Total Total
No. of Disposals No.of Pumps Tons KW No. of Sounding Devices
No. of Self Contained
No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices
No. of Dryers Heating Devices KWL Municipal [:]Other
��❑ Connection
No. of No. of Low Voltage
No. of Water Heaters KW I Signs Ballasts Wiring GLAR ALARM
No. Hydro Massage Tubs No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES 0 NO ❑ 1
have submitted valid proof of same to the Office. YES ❑ NO ❑ if you have checked YES, please indicate the type of coverage by
checking the appropriate box.
INSURANCE ❑ BOND. ❑ OTHER ❑ (Please Specify)
695.00 (Expiration Date)
Estimated Value of Electrical Work$ 2/11/99
Work to Start 2/8/99 Inspection Date Requested: Rough Final
Signed under the Penalties of perjury:
FIRM NAME ADT Security Services. Inc. LIC. NO. 1 2 31 C
Licensee nonal d A- Brooks Signature _ LIC. NO. . 1231 C
Bus. Tel. No. M3) _741-4008
Address 111 Morse Street. Norwood, MA Alt. Tel. No. (7R1) 978-1131
OWNER'S INSURANCE WAIVER: I am aware that the Liconsee does not have the Insurance coverage or its substantial equivalent as re-
quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent
(Please chock one)
35.00
Telephone No. _.._ PERMIT FEE $
(Signature of Owner or Agent)
x•G585
Latation 570 1
N{ . Date 5/3�7
N°R*� TOWN OF NORTH ANDOVER
Certificate of Occupancy $
41
Building/Frame Permit Fee $ �
Foundation Permit Fee $ �0 U
� s�cHust
ether Permit Fee $
Sewer Connection Fee $ �9
D
732 Water Connection Fee $
TOTAL $
�w 'ng I ector�
12 44 Div/ lic Works
PERMIT NO. �5-- APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS) PAGE 1
tMAP O. LOT NO. 2 RECORD OF OWNERSHIP :DATE BOOK :PAGE
ZONE I SUB DIV. LOT NO.
LOCATION PURPOSE OF BUILDING /���slG /►
OWNER'S NAME > NO. OF STORIES �7 SIZE
OWNER'S ADDRESS /Q,�/� y!l��®/ �Y� s/ / y BASEMENT OR SLAB r)
ARCHITECT'S NAME �,ayY 6®/ (� j_ n/%L �(/ L SIZE OF FLOOR TIMBERS '/GST 2ND rD 3RD
BUILDER'S NAME J�--L� ll/ rl��!_ SPAN / -- —��
DISTANCE TO NEAREST BUILDING �'1Q i� DIMENSIONS OF SI LLS --_
DISTANCE FROM STREET /f /' POSTS 6��
DISTANCE FROM LOT LINES–SIDES :9 / REAR `
9 S GIRDERS 'y�/12-
OF LOT n� /� `7 FRONTAGE Lze HEIGHT OF FOUNDATION O /[�'L THICKNESS /o r�
n f�
IS BUILDING NEW r SIZE OF FOOTING X 11
IS BUILDING ADDITION J MATERIAL OF CHIMNEY
IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND so)
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE •J ye (` Y
IS BUILDING CONNECTED TO TOWN WATER c�'� (�
`^
BOARD OF APPEALS ACTION. IF ANY /�f,�/J t J'�' CC.. IS BUILDING CONNECTED TO TOWN SEWER to
VCA✓C IS BUILDING CONNECTED TO NATURAL GAS LINE [j
INSTRUCTIONS 3 PROPERTY INFORMATION
LAND COST ' U
^LJ��)
SEE BOTH SIDES ,A.A-/1 EST. BLDG. COST
7 PAGE 1 FILL OUT SECTIONS I - 3 / v v EST. BLDG. COST PER SQ. IFT. t"4^�
EST. BLDG. COST PER ROOM V 7
PAGE 2 FILL OUT SECTIONS 1 - 12
SEPTIC PERMIT NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILE
BUILDING INSPKCTOR
81GNA
'URIE O OWNER OR HORIZED AGENT yc� �7
FEE OWNER TEL.# 4 iy `��S Z
PERMIT GRANTED CONTR.TEL.# 1755
4 Z 19 —CONTR.LIC.# 0/f/9
Lam. z_ o -.� E-2 " H.I.C.#
1 APR ,2 2 199$ I ;
i
� � r
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY \. S�OulES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMILY —Y OFFICES .LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
CONSTRUCTION
2 FOUNDATION 8 INTERIOR FINISH
CONCRETE 3 1 2 13
CONCRETE BUK. PINE _
BRICK OR STONE HARDW D
PIERS PLASTER
_ DRY WALL _
UNFIN.
3 BASEMENT
AREA FULL FIN. B'M'TAREA _
'/. 1/2 FIN. ATTIC AREA
NO BMT FIRE PLACES
HEAD ROOM MODERN KITCHEN
4 WALLS I 9 FLOORS
CLAPBOARDS B 1 2 3
DROP SIDING CONCRETE �_
WOOD SHINGLES EARTH
ASPHALT SIDING HARD%U*D
ASBESTOS SIDING COMMON _
VERT. SIDING ASPH. TILE
STUCCO ON MASONRY _
STUCCO ON FRAME G
BRICK ON --ATTIC STRS. d FLOOR I_
BRICK ON FRAME 4f
CONC. OR CINDER BLK.
STONE ON MASONRY WIRING
STONE ON FRAME
SUPERIOR 179 1 POOR
ADEQUATE r7 NONE
5 ROOF 10 PLUMBING
GABIE HIP BATH (3 f IX.( `
GAMBREL MANSARD TOIL
FLAT SHED _
ASPHALT SHINGLES A __
WOOD SHINGES IKITC14CWSINK
SLATE NO PLUMBING _
TAR d GRAVEL STALL SHOWER _
ROLL ROOFING MODERN FIXTURES _
TILE FLOOR
TILE DADO A`
6 FRAMING I 11 HEATING
WOOD JOIST PIPELESS FURNACE
FORCED HOT AIR FURN. Ix
TIMBER BMS. d COLS. STEAM
STEEL BMS. d COLS. HOT W'T'R OR VAPOR CJ \ \
WOOD RAFTERS AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS GAS
OIL
B•M'T 2nd _ ELECTRIC
1st 13rd I NO HEATING
' tfORT
F
Town of _ _ _ * _ over
� rn
No. /djP * _
LAKE dover, Mass.,
0 - •' 1
'9A_COCMICME WICK iY'�•
�G BOARD-OF HEALTH
PERIM IT T Food/Kitchen
Septic System
p BUILDING INSPECTOR
THIS CERTIFIES THAT................................36.// 09.0.................. ................................................ Foundation
has permission to erect...................I................... buildings on.......S'.?5..........Za.z.4 .....Q.k .. ...........%S.T: Rough
t0 be Occupied as.....................................S14. ..cte...... ... Chimney
provided that the person accepting this permit shall in every respect conform to th6 terms of the application on file in Final
this,office, and to the provisions of the Codes and By-Laws relating to the inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
IT
PERMEXPIRES IN 6 MONTHS Final
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION ST T Rough
................................ Service
.... . ... . ..... .. . . .......
BUILD INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
nal
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector.
Burner
Street No.
Smoke Det.
i
FORM U - VERIFICATION FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: �iUCY�iS �. ZZ Phoned: �Z :�?5 1
LOCATION: Assessor' s Map Number �� 1� Parcel
Subdivision _LL�J _' :5 �,q2�/ Lot(s)
Street - St. Number
Official Use Only************************
RECOMMENDATI S O TO AGENTS:
Date Approved I
Conservation Administrator Dates Rejected
Comments
Date Approved f
own Planner Date. Rejected
Comments
Food Ins a Date Approved Health Date Rejected
ptic Inspect r-Health Date Approved
Date Rejected
Comments
Public Works - sewer/water connections
- driveway permit
Fire Department e;,,J L.f,
re m l"'`&L Qv� &4/49J
Received by Building Inspectfor Date
• I
i
MAScheck COMPLIANCE REPORT ,
Massachusetts Energy Code Permit #
MAScheck Software Version 2.0
Checked by/Date ;
CITY: Lawrence
STATE: Massachusetts
HDD: 6235
CONSTRUCTION TYPE : 1 or 2 family, detached
HEATING SYSTEM TYPE: Other (Non-Electric Resistance)
DATE: 4-22-1998
DATE OF PLANS:
TITLE:
PROJECT INFORMATION:
WINDKIST FARMS
LOT - 2
NORTH ANDOVER, MASS
COMPANY INFORMATION:
BELFORD CONSTRUCTION
1049 TURNPIKE ST.
NORTH ANDOVER, MASS 01845
COMPLIANCE: PASSES
Required UA = 707
I� Your Home = 691
Area or Insul Sheath Glazing/Door
Perimeter R-Value R-Value U-Value UA
-------------------------------------------------------------------------------
CEILINGS 1977 38. 0 0 .0 59
WALLS : Wood Frame, 16" O.C. 3342 10 . 0 3 . 0 258
GLAZING: Windows or Doors 507 0.480 243
FLOORS: Over Unconditioned Space 1305 19. 0 62
FLOORS: Over Unconditioned Space 672 30.0 22
BSMT: 8.0 ' ht/7 . 0 ' bg/0. 0 ' insul. 214 0.0 47
HVAC EFFICIENCY: Furnace, 86.0 AFUE
-------------------------------------------------------------------------------
COMPLIANCE STATEMENT: The proposed building design represented in these
documents is consistent with the building plans, specifications , and other
calculations submitted with the permit application. The proposed building
has been designed to meet the requirements of the Massachusetts Energy Code.
The heating load for this building, and the cooling load if appropriate
has been determined using the applicable Standard Design Conditions found
in the Code. The HVAC equipment selected to heat or cool the building
shall be no greater than 125% of the design load as specified in
sections 780CMR 1310 a 4.4.
Builder/Designer
iDate � r—moi
V
't
1
1• -
i
DUCT CONSTRUCTION:
[ ] All ducts must be sealed with mastic and fibrous backing tape.
Pressure-sensitive tape may be used for fibrous ducts. The HVAC
system must provide a means for balancing air and water systems .
' TEMPERATURE CONTROLS:
[ ] Thermostats are required for each separate HVAC system. A manual
or automatic means to partially restrict or shut off the heating
and/or cooling input to each zone or floor shall be provided.
HVAC EQUIPMENT SIZING:
[ ] Rated output capacity of the heating/cooling system is
not greater than 125% of the design load as specified
in sections 780CMR 1310 and J4.4.
MISC REQUIREMENTS:
[ ] Refer to 780 CMR, Appendix J for requirements relating to swimming
pools, HVAC piping conveying fluids above 120 F or chilled fluids
below 55 F, and circulating hot water systems.
----NOTES TO FIELD (Building Department Use Only)-------------------------
I
' �•1 �
� �...
r + �
.. 1 t I .�
r� t
'J\1.1A!
f� � f � �.
.. � � i. ' 'fit, � � }
_ �
� �
� V � U _. i
C � 1
DUCT INSULATION:
[ ] Ducts in unconditioned spaces must be insulated to R-5 .
Ducts outside the building must be insulated to R-8.0.
MAScheck INSPECTION CHECKLIST
Massachusetts Energy Code
MAScheck Software Version 2.0
DATE: 4-22-1998
Bldg. ',
Dept. ;
Use '
CEILINGS:
[ ] 1. R-38
Comments/Location
WALLS:
[ ] 1. Wood Frame, 16" O.C. , R-10 + R-3
Comments/Location
WINDOWS AND GLASS DOORS:
[ ] ; 1. U-value: 0.48
For windows without labeled U-values, describe features :
# Panes Frame Type Thermal Break? [ ] Yes [ ] No
Comments/Location
FLOORS:
[ ] 1. Over Unconditioned Space, R-19
Comments/Location
[ ] 2. Over Unconditioned Space, R-30
Comments/Location
BASEMENT WALLS:
[ ] ; 1. 8.0 ' ht/7 .0 ' bg/0.0 ' insul. , R-0
Comments/Location
HVAC EQUIPMENT EFFICIENCY:
[ ] 1 . Furnace, 86.0 AFUE or higher
Make and Model Number
THERMOSTATS:
[ ] ; Adjustable thermostats required for each HVAC system.
AIR LEAKAGE :
[ ] Joints, penetrations, and all other such openings in the building
envelope that are sources of air leakage must be sealed. Recessed
lights must be type IC rated and installed with no penetrations
or installed inside an appropriate air-tight assembly with a 0. 5"
clearance from combustible materials and 3" clearance from insulation.
' VAPOR RETARDER:
[ ] Required on the warm-in-winter side of all non-vented framed
ceilings, walls, and floors.
MATERIALS IDENTIFICATION:
[ ] Materials and equipment must be identified so that compliance can
be determined. Manufacturer manuals for all installed heating
and cooling equipment and service water heating equipment must be
provided. Insulation R-values, glazing U-values, and heating
equipment efficiency must be clearly marked on the building plans
or specifications.
� �� i a'• it �
- "ski
• ' it
e
rm
NO 732
APPLICATION FOR WATER SERVICE CONNECTION
North Andover, Mass. � 192-7
Application by the undersigned is hereby made to connect with the town water main in Street,
subject to the rules and regulations of the Division of Public Works.
7 ,The premises are known as No. _ � � �� Street
or subdivision lot no.
Owner Address
Contractor Address
Applicant's Signature
�v5
l
PERMIT TO CONNECT WITH WATER MAIN
/�
The Board of Public Works hereby grants permission to �
to make a connection with the water main at_ /�O/� Street
subject to the rules and regulations of the Division of Public Works.
Board Apf Public Works
By < Z,)//x-r
Inspected by
Date
See back for rules and regulations
RULES AND REGULATIONS GOVERNING THE INSTALLATION OF WATER SERVICES
1. No persons shall tap or in any way tamper with water mains which are part of the distribution system of the Town
of North Andover without a valid permit from the Division of Public Works.
2. All water services shall be installed a minimum of five feet below the finish grade.
3. No water services shall be backfilled without inspection by a representative of the D.P.W.—Telephone 687-7964.
4. Service connections shall be 1" type k copper tubing.
5. All fittings shall be brass flange type Mueller or equal
H 15202 Corporations
H 15212 Curb stops
H 15402 Three part unions
H 8185 stop and waste valves
6. Curb boxes shall be installed at the property line and shall be of the Erie Type with 4�/z foot rod and brass plug
type cover.
TOWN OF NORTH ANDOVER, MASSACHUSETTS
DIVISION OF PUBLIC WORKS
384 OSGOOD STREET. 01845
GEORGE PERNA Telephone(508)685-0950
DIRECTOR Fax(508)688-9573
NORT,y
SA us
A�9
'1 Quo.._.., a•``y
o �
DRIVEWAY PERMIT
Date: q
LOCATION: 7D Z,)7— Z
BUILDER: phone:
i
OWNER: 6J//L/h<'/-Sr r4,t'A-f UC. phone: -z 52-a
The North Andover Superintendent of Highway Utilities&Operations MUST be notified of the
grade and set-back from street established in any driveway entry onto any street or way maintained by
the TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval
of such entry.
FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT.
Remarks: Approval:
-_" -_°jam• �%ti���-. �%�% _ � �-' IN
• -�(�� -� ��// y�� �•�-.W�%ice
LIMIT OF 100'AU—j -V
Ids V %�
1 = j - %f
EDGE or
526.00,
•
i
Growth Management Bylaw Exemption Statement
Town of North Andover Building Department
This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the
Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information
as requested below.
Name of App cant on Building Permit(below) Address of Property for Permit(below)
lon 16 _'5-M J'�-Irzl-n G"-0_4
Map and Parcel : Purpose of Application (check below)
Phort7ybeerof�plicant: Single Family _Two Family
_nFI the undersigned applicant for the above property attest that the attached building permit for which this
form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth
Management Bylaw. I also understand providing this form does not absolve me or any party to this permit
from the requirements of obtaining other permits required prior to the issuance of the Building Permit.
Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building
Department and is only officially accepted when the Building Permit ist issued.
Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the
above lot, in the building permit application and associated attachments, complies with one or more of the
following sections as indicated by a check mark.
This is an application for a building permit for the enlargement restoration,or reconstruction of a dwelling in
existence as of the effective date of this by-law,provided that no additional residential unit is created.
'The lot(s)were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning
I w.
This application is for dwelling units for low and/or moderate income families or individuals,where all of the
conditions of 8.7.6.care met and/or represents Dwelling units for senior residents,where occupancy of the units is
restricted to senior persons through a properly executed and recorded deed restriction running with the land. For
purposes of this Section"senior"shall mean persons over the age of 55.
This application is a part of a development project which voluntarily agreed to a minimum 40%permanent
reduction in density,(buildable lots),below the density,(buildable lots),permitted under zoning and feasible given the
environmental conditions of the tract,with the surplus land equal to at least ten buildable acres and permanently
designated as open space and/or farmland.The land to be preserved shall be protected from development by an
Agricultural Preservation Restriction,Conservation Restriction,dedication to the Town,or other similar mechanism
approved by the Planning Board that will ensure its protection.
This application represents a tract of land existing and not held by a Developer in common ownership with an
adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth
Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the
parcel.
This application represents a lot which is ready for building permits,(i.e.all other permits from all other boards and
commissions have been received and the project is in compliance with those permits),and the Development Schedule
does not accommodate issuing a building permit in that Year,one building permit will be issued per Year per
Development until such time as the Development Schedule accommodates issuing building permits. Applicant must
supply approved form U with this EXEMPTION.
Please provide any and all information that would assist the Building Department in making a determination'
that your application is allowed one or more of the above EXEMPTIONS.
By signing below I attest to the accuracy of the information provided and that the attached building permit is
allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or
inaccurate information, or the checking off of an above item which does not comply,whether done to my
knowledge or not, is grounds for refus I b the Building Department to issue a Building Permit.
.q ,q��
Signature of Owner or Authorized A ent who sig ned tRTAttached Building Permit ate
This form must be attached to the Building Permit upon application for such permit
G F
i
f' 1 CERTIFICATE OF USE & OCCUPANCY � .
r.
t
Town of North Andover
Ll
Building Permit Number Date
THIS CERTIFIES THAT
THE BUILDING LOCATED ON
t? .
MAY BE OCCUPIED AS . IN ACCORDANCE
! WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
oq "�;T.,tio CERTIFICATE ISSUED TO
ADDRESS `/9
. o
r "} 'dSACHUSBuildi g Inspector
,Fit•
L
it
t '
r �
t t`}
i
Mfr�ff
({
Il rffiit`t(L
i !
j,4
1 Vr
! ro 4 1 1 ,
v '
Town of Andover
0
* Z dower, Mass. 19
.F,•r' p s LAKE
'9A_COCNIC MEW I C', -
.9� qq T E D
E BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System / 44
.
/ jO y 7 jvrNyi,ee BUffDiNG INSPECTOR
THIS CERTIFIES THAT...................... .�Q.k. .................. ....Nc �,�a�dc%�
n ation
has permission to erect.:..:...........:.. ................... buildings on ....... �.......,..za z. .6.ow..........
tobe occupied as.................................... 40..cz. ....:........ �l�R. . ...................................................... imney.
!;provided that the person accepting this permit shall in every respect conform to th6 terms of the application on file in �a
.- thikoffice, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
4611dings in the Town of North Andover.
PLUMBINS E( R
-;;!V 6LATION of the Zoning or Building Regulations Voids this Permit.
PERMIT EXPIRES IN .6 MONTHS
ELECTRIC SPEC R
UNLESS CONSTRUCTION ST T IIS,
.................................... Servi
BUILD INSPECTOR
Fina
. Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Congpicuous Placer on the Premises — Do Not Remove n i
No 'Lathingor D Wall To Be Done
Until Inspected and roved b the Building- Inspector. FIRS DEPARTMENT
P � P P � � P Burner
Street No. (�"G
Smoke Det.
y
CERTIFICATE OF USE & OCCUPANCY r `
Town of North Andover
r f
1 4
Building Permit Number F Date
THIS CERTIFIES THAT
r
THE BUILDING LOCATED ON
s
,!
} MAY BE OCCUPIED AS IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
j SUCH OTHER REGULATIONS AS MAY APPLY. !x
CERTIFICATE ISSUED TO
Of
A9
ADDRESS �9
�
'-2 CHUSBuilth g Inspector
t
r r
�l � t t,f y I i• Y r ,f � +
i
1�
)
3
vl j
7
I )
+ I t
7 t
1 i }
Y
t r
111 y '
T
Town ® Andove
4.
ZZ
* z dover, Mass., 19 ?48
0 LAKE '
COCHIOHEWICK ''y'�• �w
9S oq'a
(G BOARD OF,HEALTH
IT
Food/Kitchen
Septic SysteT Dm
,o�/�! TZ,1 N pl'e BUffDiNG INSPECTOR
: va........�....a.�..d..r./...ae .................. Q. .. .. .... ..THIS CERTIFIES THAT...............................
n ation
has permission to erect.. .............:..1................... buildings on til. . .®. 77
to be occu ied as i ney
p /.. X.6..............�il� .�. .
m
'provided that the person acceptino this permit shall in every respect conform to th terms of the application on file ink/j
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PL BIN INS E oR
VIOLATION of the Zoning or Building Regulations Voids this Permit. ? LS 9
PERMff EXPIRES N .6 MONTHS
ELECTRIC SPE R
UNLESS CONSTRUCTION ST T
Sern
BUILD INSPECTOR
Fina
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Congpicuous Place'on the Premises — Do Not Remove Rough r
n
No Lathingor D Wall To Be Done
FIRE-DEPARTMENT
Until InspatedI and Approved by the Building Inspector. Burner
Street No. (�"G
Smoke Det.
dAdOON 660O A9Wvvm NOUVAIII;NOM 55VW 'dMOQNV {-I.I-dON
Z - ,j0'I SW`W( ;9MNIM NOIJ-�WGNOD
`max
� I
I
r�
II
I
I I
I i
I I
I I
I I �
I I
I I
II
I I
I I
I I
I I
• I I
I I
I I
❑ ❑ ❑ I I
LJ
---i I
HIM
I I
I I
I �
�n
II
I I
II
I I
I I
I I
I I
I
I I
I I
I I
� I I
® i i
® I I
I I
- II
I I
I
I I
I I I
I I
Lw�l I I
II '�
I i
I I
II
I I
I I
I-1
LJ
I
r-i
i Imo__
I I
OEM
I I
I i
I I
I
I I
i I
II
I I
I I
I I
I I
I I
! I
I I
I I
I I
I I
I
I I
I I
I I
" I I
I I
� I I
II
I I �
c-R I I
= O I I
z II
I I
II
I I
I I
I I
I I
II
I I
II 1
I I
I I
I I
I I r=
I I j
I I
II
I I
I I
I I
I I
I I
I
II
II
I I
i I
F.1
I I_
13-Lp
FOV CON5TRUC�'ION WINnK151'�ApMs Of - 2 �I%8'I-I'-0"
NOp1N ANnOVU, MA55
PM EI.FRION 1'Orp NOOPF-P,
FL --
II
II
II
II
II
X
II
H - - - -
� � I I �
00 I
z II
it X I
II �J
II
II
ILF
i
II ...MWIN
N ..
II
II
II
II
7Z II
�� II
O II
II
II
II 0II
II
II
II
II
13F-LIF02b CON5fpluc-10N rRo.EcrmtE:WINPK15f FApM5 1 Of - 2 scams"18
I/8"- nn,E: ffEr:
11-0" n a
Nr rm�: mm vv; �.
O�►H MOM,, MA55 1,�Ff ANO MCK�L. VAVON5 fore HOOpFII? n
� ,
i
I
• ,
��
I
Q y
Z �
O
k3
Nd1d NoudMOC
z10-,51 ,9-,4 .1&19 „9-4 .0-,51
c�A�3ta7 Nv�m
r srvxal",Q J
71ZI -------------- ----o------------ -- —D-i �-------------- ------
z Q I I
—R 7";z �� I W"01/01#9X9 L- ---------- ----- -------� I Oo
OV1 i I di /M ger-' NO7,+ I I
Q b I w d ailakrl l I
73
olx,bz x1 I
I At
I
WAX
II i1 I I NM 9 dl-.iva �ddi5 WfIWINIW..b ^' -I
I I "IO�A1N1..Z/14 I I I ZIxZ-b I I
b = I I
QL i -------4---- L-----------�--- ------� - -
�13A)Od WHd9
of b/44
wvla cn-1iw
1 zlxZ b
1 i
— d l I
0 I I I
------------
- -----------
---- ---------- - --
o - L------------------ - ------'� -
„0,51 j z/iol .0
.Z/19-,bb
,0•,69
`1
i
� I
d
I I
N
b b
_
I
� I I
-
I
7Z d O b d
ti I a
VN �n
b oo z
41
will-
I
- I
- I I
I I
-----�
b x
II o
b b b
. u
_ H N
jp'-011
Roxcf ME:
:
hF_L_Fo?pCON5TplUC_noN WINPK15r:AM5 =Xf - 2
` A
EET M nnAW6Yrr
NOM, AVCO\ \, MA55
[%?PAN 1Ot2b
HOOpF-l2
r
WAV'
I
;Ti CIO
W �
4
i 00QL
w � N
1
m o I
' I
14''0"
28'-0"
PPOY-Cf Tftr:
/81WNPK15r FP '-011��%O?P CONST:U�ION 01 -I
mm E3r;
NOp11-I ANnOV�p, MA55 s it nn�,
SFCONn FOO, PLAN
i
i I
� I
i
I 1
� I
I I I
I 1
1 �
1 ,�ur�n SLING- i
i 1
i 1
i 1
I 1
I �
I 1
1 �
I 1
I I
I 1
—2 x 8 CLING J015T5
Af 16"O.C.
C1
2-2x10
2-2 x 10
5TA R WELL
N
i 5�
rpo LCrrM: 5CAX: nAt�: S1EET;
C3F_LForlr CON5-Tluc- ION WIMR15fFARM5 1.01" -Z
M01?1'H Mll?OVEl?, MA55 ffEflm; FLAMING PL nt MPY:
AN5 1'OP12 NOOpFI:
I
I
I
2-2 X 10
I �
773
I.
N I
X
.,� 2-2 X 1 -
� I
C 773
2-2 X 10
b
- z
S�
2-2x10
5fAR vVEL
2-2 x 10
Li
I
MO ECf ME: WNnKl5f FAF\M5 2 rorn CONS' Mc-nON �I/81 -I �_0n �Er,
r
MOM ANPOV�p, MA55 %fef Me: '�""'''13Y. ���, ��A
FII?5f F OOI? F MIMG PLAN fOPP HOO►FF-p
I
N
s x
N N = 7Z
MOXCfiI11.E; 5CAU: PAZ:
P3F-P-FOP?b CON5-MUC11ON WIN19Kl5f FARM5 Of - 2
NOP?TI ANbOVM, MA55
CEILING F MING PAN -'Orr NOOPa�P2
f
�' 1� k t
v
h
I
{l
I
_ M
i
4
a
o �
l
� C
OD
77
5CU: PAT:
r�o.rcr�:WINnKlS�"�ApMS 1.01' ' Z A5 NO�b
Lt�-LFOPP CON511?UC110N
MA55
�rrnt�' �00F FPAMING PI AN ���,�; 1'OPP HOOMIP,
. N0��1 ANnOV�p,
i
I
i
i
I
I
I
i �� " ' �
1 � .
I
_ � ` , ^ � � r
"
`y
6
<ZZ,
!Wa VW
2X12Wa V
A51'YW.f 5}NU5 ON 1Z 2 X 10 ROOF MIM 0I6"O.C.
15#fELf PAPER ON 9
5/8"PLIWOco
—I X 8 COLLAR it � {�
R1VGE VENT 32"O.C. - S�
2 X 12 ME CONT.AIR CFM �� 0
2 X t0 RRAP
OOF IER @I6 D.C. ASNiW T SiINQ E5 ON Ar11C 15#FELE PAPER ON 2 X 8 CEILM J015f @ I6"D.C. -R"30 INSU ATION -_
5/8"PLYVVOOD
\ m
9 I X 8 COLLAR T5 �l�V�OOM
@ 32"O.C. l3NNooM
WWOW
FttJG �.. N
� co 2 X 10 PLOOR JO15f @I6"O.C.
E �-2 X 8 GEEING J0155@ 16"O.C. ,
N
FAMILY WOM
T PAY WWOW LIVING kOOM nINING p00M PAYW"OW
°Q
3/4"f&G PLWJOX f8G PLYWOOD R"15 MGN MN-50IN5L. � U
2 X 10 PLOOR JOIST @I6"OG. 2 X 10 FLOCK J0151 @I6"OL. / R-19 WS1LAWN
2 X 4 501.E PLATE
2 X 10 IaM J015f
= 2"2 X b SLL PLA1E
42 X 12 B11LT-W BEAM e
31/2"LALLY CD611MN SIO"CONCR fE p L 4-2 X 12 BULf Ip BEAM
I? a �A� fOJ C7A710N WfV! 13A MIf N� 3 t/2"LN LY CA WSW /-10"CONCKTE
f OMA"WALL
• 4"Pip.COKMT 5.AB X 24"PJP,
�kV/10 X 10 W,Wm, / CJNC�fE FCKIffGdr 4"KIP.CONCEM SLAB
` W/10 X 10 W.W.M. 12"X 24"P.I.P. �y
�-2'-6"Y 2'"6"X 12" CCf k1E FOOfIhJG ,
COKMTEF00%Z
2'"6"X2'"6"XIZ"
CONMfE roofm
z
51�C1101\1 1WOU61-1 t?O
FAMILY OM Q
SCALE 1/8"-''o" I3UILnING 51�C110N t
SCALE 1/8"-I'-0"
z �
Qo
v �
� � z
I
i
,^ -
� 1 M
• n w 4 • � \ � � '11
.! �, • • i